CBT for Teen Anxiety
Have you ever met a teen who seems to “have it all together”? Someone who gets good grades, is involved in activities, is polite and responsible, but who underneath feels tense, restless, or constantly on edge? If so, you’ve likely seen a teen that may have what’s often called high-functioning anxiety. These teens may appear confident and capable, yet inside they’re battling the feeling of constant worry, perfectionism, and put large amounts of pressure on themselves.
At East Side CBT, we often work with teens who feel exactly this way. Driven, high-achieving kids who are exhausted from trying to keep everything under control. Cognitive Behavioral Therapy (CBT) is a therapy technique that can be an especially effective approach for helping teens understand and manage the anxious thought patterns fueling their sense of overwhelm and stress.
What Is High-Functioning Anxiety?
A teen who experiences high-functioning anxiety often feels the need to achieve and control their surroundings to cope with insecure thoughts or feelings about themselves. While high-functioning anxiety isn’t a formal diagnosis, it describes the way that teens can present as dependable and hardworking, but their motivation is often fueled by worry. Many teens who are high achieves experience significant fears of failure, worries about disappointing others, or feeling like they are losing control.
They may be perfectionists, spending hours re-checking their homework, replaying certain social interactions over and over in their heads, or having impossible standards for themselves. While this anxiety can seem like it is helpful and productive for them, as it can look like it’s helping them stay organized and remain successful in their tasks, it can also be costly. Teens who overwhelm themselves with stress and pressure can often feel burnt-out, irritable, have trouble sleeping, and have difficulty relaxing or even feeling joy at all.
How CBT Helps Teens Understand Anxiety
CBT helps teens recognize that they way they think about a situation is just as important as the way they feel while they are in it. The fundamental idea in CBT is that our thoughts affect how we feel, and our feelings affect our behavior or our actions. For a teen with high-functioning anxiety, one thought like “If I get a low grade on this test, I’ll never succeed” can trigger intense fear and self-doubt that will make them feel tense, and ultimately cause them to decide to over-exert themselves more, thus maintaining their level of anxiety until their next task.
CBT gives teens tools to:
Notice when their thoughts are particularly anxious or perfectionistic
Learn to challenge those thoughts to identify more balanced, helpful ones instead
Change their thoughts to ones that are true and more helpful to them
Practice new ways to cope and calm their nervous system
This process not only reduces anxiety, but it also helps teens rebuild their confidence and sense of self so that their worth is not solely dependent on a flawless performance in whatever task they’re pursuing.
Common CBT Techniques Used with Teens
CBT is a type of therapy that utilizes active participation and collaboration with teens. This usually is beneficial for teens who appreciate structure and being provided with immediate, actionable strategies they can use. Common techniques include:
Cognitive Restructuring: Teaching teens to catch their thoughts before they turn into “thinking traps”. “All-or-nothing” or catastrophic thinking can be replaced with more realistic, helpful self-talk.
Behavioral Experiments: Teens will learn to expose themselves to things they fear to find out that things may not be as bad as they believe. For example, a teen may be directed to not double-check their assignment or even to try to a small mistake on purpose. This teaches teens that things usually turn better than they imagine when they are anxious.
Mindfulness and Grounding: Therapists work with teens to help them become aware of physical signs of stress and regulate their nervous system through breathing or sensory awareness.
Tolerance Building: Teens will learn building tolerance for frustrating or overwhelming feelings, including the fear of “not knowing” or not being perfect. Therapists will help a teen to learn that anxiety passes without needing to overly control their surroundings.
Why CBT Works So Well for High-Functioning, Anxious Teens
Teens with high-functioning anxiety are usually great candidates for CBT because they can be motivated and have a strong desire to understand themselves. The structured format and easy to follow coping skills gives them something to do with their anxiety rather than try to talk through it. They will learn that the goal isn’t to get rid of their anxiety completely but to respond to it differently to manage it.
Over time, CBT helps shift the focus from needing to perform to needing to find balance. They can often learn that rest, fun, and connection are just as valuable as success and achieving.
Supporting Teens Beyond the Therapy Room
Parents often wonder how they can help their child with the goals in therapy. Therapists often encourage parents to reinforce the skills learned in the sessions at home to ensure that their children are benefitting from what they are learning. A CBT-informed approach at home includes:
Keeping the focus away from outcome and more on the effort they are putting into their tasks
Praising their abilities to be flexible and to use self-care strategies
Parents can modeling how to handle mistakes calmly themselves
Allowing their teens time to rest and recover without guilt or pressure.
Successful treatment outcomes in therapy require practice of the skills in both neutral times when not experiencing stressors, and during times of actual stress. Most people see success with therapy when they practice skills outside of the office, including with loved ones at home, so they can know how to use them when things get tough.
Getting Help at East Side CBT
At East Side CBT, our experienced therapists specialize in working with adolescents who appear “high-functioning” but are struggling with crippling anxiety beneath the surface. Using evidence-based CBT strategies, we help teens begin to understand what anxiety is and how their anxiety presents. We then teach teens to challenge and reframe their thoughts as well as how to use coping strategies to manage when stress arises.
If your teen seems overwhelmed with stress or anxiety, even though they are seemingly doing everything “right”, CBT can help them find balance, confidence, and peace of mind without losing the drive that makes them uniquely them.